ACA Coverage of Colonoscopies

If the cost of health care is weighing heavy on your mind, you’re not alone. A 2013 Gallup poll found that 30 percent of Americans put off medical treatment because of the expense. But if you’ve been avoiding a colonoscopy because you’re afraid of the bill, you may not need to worry. Under the Affordable Care Act (ACA), your colonoscopy could be mostly covered – or completely free!

The ACA requires private insurers to provide coverage of preventive colon cancer screening tests, such as a colonoscopy, with no cost-sharing to the patient. This does not apply to grandfathered plans that were already in place before the ACA was passed, but you may still have coverage under state laws. If your coverage began on or after September 23, 2010, your plan is required to cover preventive colonoscopies and other colon cancer screening tests.

Even if your colonoscopy is fully covered, you could still be responsible for some expenses. Patients are sometimes required to pay for anesthesia, bowel prep, pathology and facility fees. If you are experiencing symptoms, such as rectal bleeding or changes in bowel habits, or if you have a history of colon cancer, your colonoscopy may be considered diagnostic instead of preventive, and you could incur charges (Source:

To determine what your out-of-pocket expenses will be for your colonoscopy, it is best to contact your insurance company directly. Ask them about your cost-sharing responsibility for the procedure, and request a total amount. Be sure to verify that you are using an in-network doctor and facility, as an out-of-network provider will incur much higher expenses. It is also a good idea to contact your doctor’s office to inquire about the cost and how the procedure will be coded (Source:

The cost of any medical procedure can be daunting, but you may find that a colonoscopy isn’t nearly as expensive as you’d anticipated. If you’re over 50 and have never had a colonoscopy, talk to your doctor today! It’s a life-saving procedure that is vital to your health, and you can’t put a price on that! 

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